Dying in silence: How abortion kills Filipino mothers

MANILA, Philippines –Amelia, 35, was sure she was dying. She was lying in bed in the emergency room of a busy hospital in Manila. Her dress was drenched in blood. Her stomach was in terrible pain.

Patients recuperate from post-abortion complications at the Fabella Memorial Hospital (Photo taken by Elena Masilungan for Newsbreak)

It happened almost a year ago. Her husband brought her to the hospital because she had been bleeding for three days. It got to a point when she had to change her sanitary pad every 30 minutes. Paracetamol only made the pain in her stomach worse. “I was so weak I could not even sit up. I got scared and went to the hospital.”

Amelia was suffering from complications due to induced abortion.

When she found out she was pregnant, she began seeing the hilot in their neighborhood thrice a week for three weeks for “massage” sessions. The hilot kneaded, poked and pressed her stomach for 10 to 15 minutes during these sessions. On the fourth week of her “massage” sessions, she started bleeding.

It was painful. It was also a crime.

A street vendor whose husband ekes out a living as a “pedicab” driver, Amelia considered her pregnancy as just another expense, “gastos lang.”

Amelia’s case is by no means unique. A study done by the Guttmacher Institute said that in 2008 alone, 560,000 induced abortions were performed in the Philippines.

Amelia took the risk because she and her husband could no longer afford another—their 9th, supposedly—child to feed. A street vendor whose husband ekes out a living as a “pedicab” driver, Amelia considered her pregnancy as just another expense, “gastos lang.”

During an interview in their one-room shanty in Manila, Amelia was putting to sleep her one-year-old infant. Her two eldest children were not home, but neither were they in school. Her nine-year-old son was working as an errand boy in a nearby restaurant, while her 10-year-old was busy manning a car park by the streets.

Only her seven-year-old daughter was in school. The four other kids were with Amelia’s mother, since Amelia had to work.

Unsafe methods

Because abortion is illegal here, women like Amelia are forced to go to clandestine abortion service providers who use unsafe methods, at great risk to their health and their lives.

It is among the top five reasons why the number of mothers dying from pregnancy continues to be fairly high in the Philippines, according to data from the health department.

Making things worse is the attitude of many health professionals toward women who choose to abort their pregnancy. Apart from harboring their own moral judgments, these health practitioners hesitate to treat post-abortion patients for fear of criminal liability.

Amelia was lucky. Timely medical attention helped her survive.

In many cases, the women die because whenthey suffer from post-abortion complications they delay going to the hospital for treatment.

In an overwhelmingly Catholic country where the Church remains an influential voice, terminating a pregnancy is generally equated with murder. There is very little sympathy for women who opt for it.

Women suspected of having induced abortions often receive unsympathetic treatment if not outright threats from medical professionals. The moral judgment made by medical professionals can be so sweeping at times that even those who had spontaneous abortion are initially suspected of undergoing induced abortion.

Almost every year, unsafe abortion takes more lives than the dreaded dengue fever, which caused a little over 700 deaths last year.

As such, they are subjected to the same unsympathetic treatment, until such time that a final diagnosis is made that indicates they had, indeed, suffered from spontaneous abortion.

That’s what you get

Amelia felt the censure almost immediately upon entering the hospital’s emergency room.

It was her husband who explained Amelia’s condition to the nurse at the reception desk. The nurse glared at her for a few seconds, Amelia recalled. She then left and came back minutes later with a doctor who asked Amelia where she was hurting and what she was feeling.

“After answering him, he next asked me in a loud voice if I had an abortion,” Amelia said. “There were people near us who heard him and they all looked at me.” She felt the judgment in their eyes. “They seemed to be saying, ‘that’s what you get for getting an abortion,’” Amelia related in almost a whisper.

Amelia did not answer the doctor directly. She told him was that she had a miscarriage (“nakunan”), or a spontaneous abortion, which happens without medical or surgical interventions. The doctor looked at her and shook his head but said nothing more.

In countries where it is legal, abortion is done through surgery or medication. In the Philippines, women wanting to terminate their pregnancies do it through such means such as an abdominal massage, by inserting hazardous objects in the uterus, by ingesting abortifacient drugs or substances, or even simply by doing intense physical exertion.

Asked why she lied, Amelia explained, “I did not want to admit to the doctor I had an abortion. I don’t think any woman can readily admit that. How can a mother admit to another person that she killed her child?”

After the doctor left her, a nurse sat Amelia in a wheelchair and led her to the obstetric ward. The nurse told her in a sharp tone, “Don’t lie when she asks you if you had an abortion. If you lie, we will report you to the police. Besides, it’s obvious you had one.”

Amelia was burdened with mixed feelings. “I was so scared I might die or if I live, they will get the police to arrest me.” She was also getting furious. “I was bleeding heavily. I could feel the blood trickling down my legs. My dress was also soaked in blood,” she narrated. “I knew they were deliberately delaying treating me because I had an abortion.”

“I kept thinking of my children. The eldest was just 10 years old. What will happen to them if I die?”

Meantime, the pain kept getting worse. “I kept thinking of my children. The eldest was just 10 years old. What will happen to them if I die?,” she said.

Amelia had reason to be angry.

“I have witnessed many times how the health staff can be very judgmental in dealing with post-abortion patients,” observes an OB-Gyne doctor, who agreed to talk only on condition of anonymity.

Guilty feelings

The doctor, who is a consultant with the Dr. Jose Fabella Memorial Hospital, the largest maternity hospital in Metro Manila, admitted that it is very common to hear “self-righteous remarks” from health professionals when they talk to post-abortion patients. “They make the patients feel guilty for their ‘crime.’”

Anti-RH bill advocates sign up onlookers to pray the rosary “for the conversion of those involved in seeking or providing abortion" (Photo taken by Elena Masilungan for Newsbreak)

Dr. Alejandro San Pedro, chair of the Department of Obstetrics and Gynecology of the Bulacan Provincial Hospital, agreed that such situations do happen. “The influence of the Catholic Church is deeply ingrained in some doctors that it affects the way they behave toward their patients,” he said.

The code of ethics of the Philippine Medical Association (PMA) is clear on what it expects from doctors: to provide competent medical care with full professional skill in accordance with current standards of care, compassion, independence, and respect for human dignity.

But in reality, many doctors do not meet this expectation when it comes to dealing with post-abortion patients.

Flora, a 23-year old single mother of three, experienced this when she sought treatment in a private tertiary hospital for high fever, severe stomach cramps, and heavy bleeding after ingesting the drug , a drug known for its abortifacient qualities.

“The scolding came first before the treatment,” relates Flora. “The doctor reprimanded me and told me I committed a grave sin. She told me, ‘You may still be alive but your soul is already burning in hell.’”

All Flora could do at the time was cry.

Some doctors admitted threatening their patients that they will be reported to the police just to stop them from lying or from being evasive about their true situation.

Some doctors we interviewed explained that they resent having to spend crucial time on a patient who is lying about her condition. “Admittedly, you can get impatient,” said Merlinda Montinola, chief resident of the OB-Gyne department of the Philippine General Hospital.

It is frustrating when a patient keeps on denying that she had an abortion when all her symptoms point to that, Montinola said. “You would want to know what she did because the treatment for induced abortion is different from spontaneous abortion.” When no amount of explanation would make the patient tell the truth, Montinola said, “you cannot help but sound irritable and unsympathetic.”

This mood can be aggravated when the doctor is overworked and very tired, she added.

Some doctors admittedthreatening their patients that they will be reported to the police just to stop them from lying or from being evasive about their true situation. They clarified, however, that these are often empty threats— meant only to make the patient realize that what she did was illegal and risky.

Hopefully, these doctors said, the patient will be frightened enough and avoid a repeat in the future.

Legal and moral bind

There are doctors who feel they are in a bind when treating post-abortion patients because of the legal responsibility attached to induced abortion.

“Some doctors think that completing an induced abortion and providing post-abortion care mean they are continuing the crime,” according to Junice Melgar, executive director of the Likhaan Center for Women’s Health. The center is a nongovernment organization that promotes the health and rights of disadvantaged women and their communities.

Melgar maintained that these fears are baseless. “The crime has been done already. And doctors are supposed to do their ethical role, which is to treat life-threatening complications.”

The specter of potential criminal liability, however, clearly affects the way health professionals and institutions deal with post-abortion cases.

In a forum on post-abortion care attended by health professionals, the assistant chair of the OB-Gyne department of a tertiary teaching hospital in Metro Manila revealed that they would direct their security guards to have the names of post-abortion patients listed in the police blotter.

The administration of the hospital, which is right across from a police station, was under the impression that they are required to do this. Curiously, no police ever came to the hospital to investigate.

Lawyer Claire Padilla, executive director of the NGO EngendeRights, who was in the same forum, asserted that the law is not categorical in requiring doctors and hospitals to report to authorities women who had induced abortion. This should explain the police’s lack of action against post-abortion patients in the said hospital.

“The crime has been done already. And doctors are supposed to do their ethical role, which is to treat life-threatening complications.”

There are doctors as well who refuse to treat post-abortion patients because to do so would be against the dictates of their conscience.

Doctors who admitted they turned away patients in the past told Newsbreak that they referred the cases to other doctors who were less conflicted. Likewise, in situations when they are the only ones available, these doctors said they eventually provide their patients with competent medical care.

In such situations when they are forced by circumstances to attend to post-abortion patients, however, the behavior and attitude of these doctors toward such patients sometimes go against the PMA code.

Training for doctors

Hospitals generally have an accountability mechanism that allows patients to complain if they experienced less than professional behaviors from their staff, including doctors and nurses. It is, in fact, a requirement for PhilHealth accreditation.

Most post-abortion patients, however, ignore these violations of their rights and prefer to suffer in silence.

Dr. San Pedro said training is crucial in changing the way medical professionals perceive women who undergo abortion. “Medical professionals must learn how to respect women and their reproductive rights. Our training when it comes to post-abortion care and treatment is heavy on the biomedical aspect. It’s time to devote as much emphasis on the ethical values of medical professionals in responding to the needs of post-abortion patients,” he explained.

One hospital, the Brokenshires Integrated Health Ministries in Davao City, has been doing this for some time now through its Woman Center. This health institution is managed by the United Church of Christ, a Protestant group.

Brokenshires’ Woman Center conducts regular training for residents, nurses and midwives on ethics and quality of care. The training has a specific section for post-abortion care that incorporates not just clinical discussions of cases but also the ethical practices involved.

“We recognize that even if our personal belief is against abortion, it is not right to reflect this in our attitude toward our patients,” said Dr. Darlene Estuart, project director of the center.

Estuart sees the value of exposing residents to nonclinical work and having them interact with poor women, abused women, and women in prostitution, who comprise a significant number of post-abortion patients.

“By experiencing this, they’ll know first hand these women’s daily struggle and the ordeals they have to go through in life. Hopefully, when someone like them becomes their patient, they’ll be less judgmental, more compassionate, and more respectful to them,” she explained. (Next: Desperate women seek desperate measures)–Newsbreak

The series was produced under theMaggie de Pano Fund for Investigative Reporting on Health.The Fund, which is managed by Newsbreak, ismade possible through a grant from Macare Medicals, Inc.

ako, aside from demonstrating the wholly unwarranted rudeness on important social issues which is possibly and sadly all too characteristic of today’s average Filipino, you are arguing a false dichotomy between abortion and restraint. He said he is pro RH bill, which, if you ever deigned to clap eyes on the actual text of said bill, you will speedily discover does not legalize or even approvingly mention abortion at all. In fact, the actual text of said bill also provides for sex education. Anyone who is enlightened and concerned for their own welfare could and no doubt would use said sex education to conclude that restraint is the wiser choice.

I do wish there were far, far less of your rude and flimsily argumentative ilk posting online these days, but personal observations give me little hope.

making the RH bill a law will surely make a big positive effect to the decrease of these cases (induced abortion). sex education beginning in the earliest possible time should be very helpful.the promotion of the use of birth control may it be natural or artificial and mechanical are much better than abortion. and with the RH bill, the promotion to the use of these will be stronger.
i am against abortion except in cases that it is really needed (e.g. ectopic pregnancy).

with the issues involving some doctors’ treatment to post-abortion patients, i think it is not still right to treat them rudely. in war, even opposing sides have the responsibility to treat the other side when there is ample time. it is their priority to make people live and not to watch them die whatever are their sins especially for a medical practitioner. not giving attention and giving emotional pressure to these patients are no different to the patents anymore. threats even though they are empty don’t do good. there are gentler ways to make them tell the truth.

Mandating by a sweeping law about contraception and population reduction just to “force” medical practitioners to do their duty is way off mark or illogical… This poblem (as discussed by the article above)can be addressed by what the article said: training for doctors and hospital staffs (and their adhrence to their medical professional code of ethics)… Post-abortion women sufferers are not the only patients who have undergone seemingly unprofessional treatments or the not-so-good manner by hospital staffs especially govt-owned hospitals… (i dare Newsbreak to do a REAL survey regarding what kind of patients that will most likely receive mistreatment… i predict those patients that can ill-afford hospitalization costs and the marginalized ones…) That’s why it is not ONLY the post abortion women sufferers’ needs that should be looked into or taken into consideration when thinking about contraception and population reduction bills.

When it is mandated by law that these women can avail of contraceptions and artificial birth control devices FREE without taking into consideration their moral sense, decisions are already provided for them… In the first place the current situation is that it is NEVER ILLEGAL to buy contraceptives whtever and however one wants it… So, the premise to give them choices is already biased from the start.. So much so, when you mandate it by the force of law it become a ready made decision for these women…Thus, this is not helping people to make a choice, rather this bill is helping people to disregard any other options but sex without the accompanying responsibility of pregnancy.

Proper education of patients and healthcare providers is the magic key, RHB is the responsible guideline, church authority is the moral conscience and abortion, whether legal or illegal, is not the answer. Medical contraception when properly done is safe and good preventive care!

Jj statement above about ectopic pregnancy. Clarification only.
Ectopic pregnancy is pregnancy outside of the uterus. Abortion is not performed in this case because it is an abnormal form of pregnancy. Usually emergency surgery is done because the patient has symptoms like abdominal pain. The most common site of ectopia is the fallopian tube and the symptoms mimic appendicitis sometimes. There are certain diseases where therapeutic abortion is medically recommended like anencephaly and Tay-Sach disease, common among those with Jewish trait.

One good reason PMA should participate actively in crafting RHB endorsing only legal maternal treatment by certified Gynecologists of medically documented (ultrasound and DNA) fatal fetal illnesses like anencephaly, Canavan syndrome or Tay Sach. These latter 2 illnesses are examples of congenital genetic diseases associated with parents of Jewish, Mediterranean or European traits. Considering the many OFWs in the Middle East and European regions, it would not be far fetched the traits could be carried by Filipino women with interrracial relations.